Pediatrics

Pediatrics

World’s first pediatric hospital, Paris

Pediatrics, from paidí, child and iatrós, doctor, is a relatively new–since the 1800s–field of medicine. The first hospital specifically dedicated to the care of children, l’Hôpital des Enfants Malades opened in 1802 in Paris*. The cynical amongst the readers might point out that medical practice of the era was still pretty barbaric: the first operation with anesthesia was performed in 1846 (Boston) and the first operations using an antiseptic (carbolic acid) were reported by Joseph Lister in 1868 (Glasgow). Vitamins had yet to be discovered so management of scurvy and rickets were both empirical exercises. And effective therapy for infections including erysipelas, strep throat and tuberculosis was still decades away.

*This was soon followed by a pediatric pavilion at the Charité (Berlin), Saint Petersburg, Vienna, and Wrocław/Breslau (all in the 1830s). The Brits and Yanks followed suit with the GOSH (Great Ormond Street Hospital in London, 1852), and children’s hospitals in Philadelphia (1854), Edinburgh (1860) and Boston (1869).

A seriously ill child admitted to a hospital in the 1800s had, like a seriously ill adult, a greater chance of being discharged through the morgue than through the main entrance. However, by the early 20th century, mortality and morbidity had declined to the point that Lawrence Henderson, a professor at Harvard Medical School observed that medicine had crossed what he called the Great Divide, when “…for the first time in human history, a random patient with a random disease consulting a doctor chosen at random, stood better than a 50-50 chance of benefitting from the encounter”.

baby teething on stethoscope

The 20th century saw innovations that impacted on all fronts of child care, ranging from prevention to management. The first half of the 20th century saw the first well-baby clinic (Dr EP Bacon, Philadelphia) and development of vaccines for diphtheria, influenza, pertussis, and tetanus. In the latter half of the century, polio, measles, mumps and rubella vaccines became available. New diseases–e.g., sickle cell anemia, cystic fibrosis, were discovered, and old ones, e..g., Hodgkin disease, were re-classified, here, as a malignancy. Medical conditions that had been functionally debilitating in children–e.g., behavioral disorders, became manageable with benzedrine, an amphetamine. Others, which had previously been virtual death sentences–e.g., systemic infections, became curable with penicillin and the war chest of antibiotics that followed. The 20th’s final frontier, cardiovascular surgery of the infant heart, was attacked, if not conquered by Drs Taussig and Blalock, and saw the first palliative management of the tetralogy of Fallot, a congenital heart disease that kills 75% of those with it by age 10.

Pediatrics in the 21st century is tasked with managing the impact of known infections–e.g., TORCH* and HIV-1 in mothers with AIDS, as well as emerging infections including West Nile, SARS, norovirus, MERS, dengue, Ebola, influenza AH7N9, chikungunya and, the most worrisome of the lot, Zika virus, given its intimate link to microcephaly in the first trimester of pregnancy. The bad news for children in the 21st century is not just the infections, but that the world has gotten much uglier. With the raised scepter of terrorism, mass shootings, sexual abuse, famine, refugeehood and use of chemical weapons, it’s increasingly difficult, even for those living in developed regions, who are inured from these disasters, to hope that the pendulum will swing to the positive in the foreseeable future.